When you hear the phrase “value-based care,” physicians and patients immediately come to mind. But what about the technical systems and platforms that store, manage, and integrate health data? Value-based care begins well before critical care decisions are even made—patients must be top-of-mind in the design and evolution of both EHRs and data perspective and approach, both in how we work and the technologies that power it. By taking a patient-centered approach to technology, innovation and impact will undoubtedly follow.
While there’s still much to be done (and undone), all is not lost. By looking back at how our current system evolved, we can identify strategies for future success.
Put patients first
Not all patient data is collected in a single clinic, in a single hospital, or a single office—but at the center of these interactions is a single patient. Had we prioritized the needs of the patient from the outset—data privacy and security, the capability of the entirety of their data to follow them regardless of provider, care organization, or location—we would have designed a patient-focused, fluid healthcare learning system from the start.
Let high expectations take the lead
Policies that built EHR systems were narrow in their scope and inadvertently gave vendors more power than providers. Compromises were made to encourage adoption while consensus on standards for data sharing was minimal. This created an environment with little consideration to data exchange. Vendors were empowered to build functionality that satisfied the minimum requirements of the law, and too little consideration was given to facilitating the holistic care of a patient across all providers engaged in their care.
Consider EHRs as change agents
EHRs focused on computerizing existing workflows rather than changing workflows and behaviors to ensure data is collected in a way that allows it to be integrated, shared, and reused for research, discovery, and evidence generation. In truth, we computerized what we used to do on paper without regarding long-term, evolving needs in clinical research and care.
Where the patient goes, the data follows
The patient is ultimately in charge of his or her care and will cross EHR lines to interact with competing providers over a lifetime. In turn, EHRs must incorporate data across various care providers, organizations, and settings. In fact, it could be argued that most patients assume this is not only possible, but that it’s already happening. And why shouldn’t they expect their data to follow them from one provider to another and from one environment to another, in the same way they can access their money from any ATM, anywhere? It’s not only their data, but it’s also in their best interest from safety, quality, and outcome standpoints.
Build more connections, not more silos
Lack of interoperability is at the core of nearly every EHR problem. Under current criteria, we can claim interoperability between two EHRs by demonstrating that we moved data from one EHR to another at least once. Not that we can do it systematically or reproduce it, not that we can do it across multiple providers of EHRs—just one point-to-point connection. If we can’t combine data from multiple environments, physicians and researchers from different systems and organizations will struggle to collaborate on care and discovery, and we will never be able to ask and answer important questions.
Care is complex; technology is but one part of an overall strategy. But without sharing, integration, and interoperability across multiple vendor platforms and sources, we will continue to fall short of what we could be doing for patients and their families. Merely capturing data is not enough. We need technology that allows us to integrate and share data in a matter of minutes and mouse clicks; we can’t accept months and years to merely assemble datasets, much less use them. How do we start generating value beyond the current baseline, today?
Through true interoperability, a patient-centered, data-driven, value-based healthcare system is achievable. But realizing this shared vision requires surmounting substantive challenges related to the collection, storage, management, analysis, and dissemination of data. It can be accomplished via corresponding strategies: An EHR-agnostic approach to data integration and sharing and the use of novel platforms and methods to connect EHRs with no single standard and no changes to existing vendor technology.
As innovators, we believe technology plays a central role in how data is used to cure disease. But modernization rarely comes easily or without trials. True advancement lies in collaboration among clinicians, researchers, and vendors. Just as the whole of healthcare data is greater than the sum of its parts, we, too, can accomplish a value-based healthcare system by putting patients first—together. And here’s the good news: We don’t need to wait.